Service de Physiologie Clinique et de l’Exercice, CHU Saint-Etienne, Faculté de Médecine Jacque Lisfranc, EA SNA EPIS 4607, UJM, Saint-Etienne, Pres de LYON, France.
Hypertension. 2012 Nov;60(5):1324-31. doi: 10.1161/HYPERTENSIONAHA.112.193409. Epub 2012 Oct 8.
Previous literature has shown mixed results regarding the association between blood pressure levels and brain volume reduction. The objectives of this study were to determine whether high blood pressure levels were associated with focal brain volume reduction and whether high blood pressure-related focal brain volume reduction was associated with a decline in executive function performance. On the basis of a cross-sectional design, 24-hour ambulatory blood pressure measurements, as well as brain morphology from 3-dimensional magnetic resonance images, were assessed among 183 participants (mean, 65 ± 0.6 years; 62.4% women). Average levels of systolic and diastolic blood pressures, as well as dip, pulse pressure, and mean arterial blood pressure, were used as outcomes. Cortical gray and white matter volumes were determined by automatic calculation using Statistical Parametric Mapping segmentation. Folstein's Mini-Mental State Examination, digit span, part B of Trail Making, and Stroop tests were used to assess executive function performance. Sex, use of antihypertensive drugs, duration of hypertension, leukoaraiosis, body mass index, education level, and total brain matter volume were used as potential confounders. A significant blood pressure-related decrease in gray matter volume of the left supplementary motor areas (Brodmann area 6) and of the left superior and middle frontal gyrus (Brodmann area 8) was shown. No significant decrease was found with white matter volume. Blood pressure-related decreases in gray matter volume were significantly associated with a decline in executive function performance. The association of high blood pressure with brain volume reduction may in part explain blood pressure-related cognitive decline leading to dementia.
先前的文献表明，血压水平与脑体积减少之间的关联存在差异。本研究的目的是确定高血压水平是否与局灶性脑体积减少有关，以及高血压相关的局灶性脑体积减少是否与执行功能表现下降有关。基于横断面设计，对 183 名参与者（平均年龄 65 ± 0.6 岁，62.4%为女性）进行了 24 小时动态血压测量和 3 维磁共振成像的脑形态评估。平均收缩压和舒张压水平，以及收缩压下降、脉压和平均动脉压均作为结果进行评估。皮质灰质和白质体积通过使用统计参数映射分割的自动计算来确定。采用 Folstein 的简易精神状态检查、数字跨度、Trail Making 测试部分 B 和 Stroop 测试来评估执行功能表现。性别、降压药物使用、高血压持续时间、脑白质疏松症、体重指数、教育程度和总脑物质体积被用作潜在混杂因素。结果显示，与血压相关的左侧辅助运动区（Brodmann 区 6）和左侧额上回和额中回（Brodmann 区 8）灰质体积显著减少。白质体积没有显著减少。与血压相关的灰质体积减少与执行功能表现下降显著相关。高血压与脑体积减少的关联可能部分解释了与血压相关的认知能力下降导致痴呆。
